We investigated the effect of aging on nerve conduction parameters in 184 subjects (aged 10-75 years) without any history or signs of peripheral neuropathy, in order to clarify the diagnostic parameters of demyelinating neuropathies in the aged. The CMAP amplitude ratio (proximal CMAP/distal CMAP), duration ratio and area ratio remained unchanged throughout the second to eighth decades. The lower limits of normal CMAP amplitude ratio (mean -3SD) were 0.79 (median nerve), 0.74 (ulnar nerve), 0.59 (peroneal nerve), and 0.48 (tibial nerve). The upper limits of normal CMAP duration ratio (mean 11+3SD) were 1.22 (median nerve), 1.19 (ulnar nerve), 1.35 (peroneal nerve), and 1.32 (tibial nerve). The lower limits of normal CMAP area ratio (mean-3SD) were 0.84 (median nerve), 0.78 (ulnar nerve), 0.61 (peroneal nerve), and 0.62 (tibial nerve). There were no age-related changes in amplitude ratio or duration ratio of SNAP, although the standard deviations increased with age. Since the amplitude ratio, duration ratio and area ratio are simple and age-independent, they can provide useful and reliable information for routine nerve conduction studies for aged patients with demyelinating neuropathies.
We investigated 952 consecutive autopsy cases between January 1990 and May 1994 to identify ruptured infectious aneurysms (IAs) of the aorta or iliac artery. Twenty patiens (2.1%) died of artrial rupture, including 9 men and 11 women. The cause of rupture was IA in four cases (0.42%), atherosclerotic aneurysm (AA) in nine (0.95%), dissection (D) in six (0.63%), and aortoenteric fistula due to irradiation in one (0.11%). Infection of pre-existing aneurysms was considered to be AA rather than IA and the patient with aorto-enteric fistula was excluded from the study. Patients with IA were significantly older than other patients (IA: 85.8±4.3, AA: 80.2±4.1, and D: 77.7±5.0 years old), and were less frequently accompanied by leukocytosis than patients with AA, although this difference was not significant (11, 100 vs 13, 000). The four patients with IA consisted of one man and three women, all of whom died suddently. Two patients had perforation in the atherosclerotic descending aorta and the other two had perforation in the atherosclerotic common iliac artery. Histological examinations revealed marked neutrophilic infiltration in all four cases, and bacterial colonies in three cases. In conclusion, IAs were not rare. Since they often cause sudden death, special attention should be given to elderly patients who develop infection.
An epidemiological study on 17 consecutive elderly malignant lymphoma patients age 65 years or over was performed and the clinical outcome of chemotherapy is reported. Of there, 131 patients (75.7%) had non-Hodgkin's lymphoma (NHL) and 21 patients had Hodgkin's disease (HD). As for clinical staging, 58.9% of patients were in stage 3 or 4. The initial sites were nodal in 61.8% of the patients the most common sites of involvement in superficial lymph nodes being cervical, inguinal and axillar. The most frequent site of extranodal involvement was the gastrointestinal tract. The cases were treated with CHOP/COPP, BACOP or COP-BLAM combination chemotherapy. The clinical efficacy of these modalities was similar, with complete remission rates being about 50%. However, the total response rate (CR+partial remission) by the COP-BLAM regimen were 88.1%. The median survival time of cases adhieving CR, was longer than 47 months. The most frequent cause of death was infection, especially pneumonia and septicemia. Many elderly ML patients were found and diagnosed when the disease developed to an advanced stage. Therefore it is necessary to make efforts to find early ML patients by screening apparently healthy elderly people. Improvement of the complete remission rate should be obtained if vigorous and intensive chemotherapy is carried out with careful supportive therapy concerning the general condition and complications in patients.
To examine the fibrinolytic system and platelet factors (PF4 and β-TG), we conducted a venous occlusion test (V.O. test) on two groups of elderly patients suffering from cerebral infarction, one group being able to walk (A group), the other being bed-ridden for during a long period (B group). Their levels of t-PA, PAI-1 antigen and platelet factors were compared between A or B, A+B and healthy elderly groups. The t-PA antigen level of both group A and B after the V.O. test tended to increase: The t-PA values of A+B groups after the V.O. test were also similar to that of the healthy elderly. The PAT-1 antigen level of both group A and B before the V.O. test was higher than that of the healthy elderly. However, the PAT-1 antigen level of both group A and B tended to decrease after the V.O. test. No remarkable changes were noted in PF4 and β-TG, which have been thought to reflect platelet function. The above findings suggest that the fibrinolytic activity in A or B groups can recover through stimulation by exercise training and some medical treatment.
We conducted a questionnaire survey on the awareness and feelings of elderly patients and their families concerning their diseases and prognosis during terminal hospitalization. Sixty-five families of 177 patients who died at our hospital in 1992 answered questions concerning estimation of the prognosis, understanding of the disease, satisfaction regarding explanation of the disease, wish to be informed of the diagnosis, feelings during hospitalization, and whether the family revealed the diagnosis to the patient. Patients with malignancy were not informed of the true diagnosis at this time. As to estimation of the prognosis, patients aged 70 or older who did not expect “cure” of their diseases at first were significantly fewer, and those anticipating “death” just before dying were significantly more frequent than those under age 70. In patients with malignancy, those aged 70 or older foresaw “incurability” at first significantly more frequently than those under age 70. Patients with malignancy knew the diagnosis in significantly fewer cases, believed the false diagnosis significantly more frequently, and showed dissatisfaction with the explanation of the disease significantly more frequently, than those with non-malignancy. Proportions of the family who told the diagnosis to the patient were 11.8% in malignancy and 38.8% in non-malignancy with statistical significance. These data indicate that medical care during terminal hospitalization should be modified principally based on informed consent, if that is the wish of the patient.
Endoscopic examinations of the elderly have been increasing annually due to increase in the size of the elderly population, and due to the development and increased use of upper gastrointestinal endoscopy. The reserve potential of the circulatory system is frequently diminished in the elderly. Thus, a minimal load on the circulatory system can induce a critical status. Therefore, the effects of endoscopic examination on the circulation, most notably on the heart itself, was examined in the elderly (over 60 years old) and in younger (under 30 years old) individuals. Atrial and ventricular load were evaluated by measuring the concentration of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP), both before and after endoscopic examination. These peptides are secreted by myocardial cells in reaction to sharp increases in cardiac load. No significant difference was observed between the blood pressure of the elderly group (21 cases) and that of the young group (10 cases), either before or after endoscopic examination. However, the pulse rate was raised significantly after the examination in both groups. Furthermore, the hANP concentration was significantly higher after the endoscopic examination in the elderly group, although no notable difference in hBNP concentration was observed after endoscopy. In the younger group, the hANP concentration did not change significantly, but the hBNP concentration was notably lower after the examination. Increased atrial load during endoscopic examination of the elderly was indicated by these observations. Therefore, overall patient status must be correctly evaluated, with particular recognition of potential circulatory system damage, when endoscopic examinations are performed on the elderly. In addition, the measurement of blood hANP and hBNP concentrations was shown to be an effective index for evaluating cardiac load during endoscopy.
Evaluation of cardiac function is very important in elderly patients because it is closely related to the prognosis. Appropriate evaluation is especially important to treat and prevent the progression of dementia since its pathology differs greatly depending on type. In the present study, we evaluated the cardiac function of patients with senile dementia using echocardiography. Included in the present study were 11 patients with Binswanger-type dementia (BD), 12 with cerebrovascular dementia (VD) of other types, 16 with senile dementia of Alzheimer-type (SDAT) and 15 controls. Left ventricular function was assessed by Mode M based on left ventricular end-diastolic dimension (LVDd), left ventricular end-systolic dimension (LVDs), left ventricular dimension shortening (FS), left ventricular ejection fraction (EF) and cardiac output (CO). LVDd was significantly larger in the BD group than in the control, and LVDs was also significantly larger in the BD group than in the three other groups. FS was significantly decreased in the BD group compared to the SDAT and controls. FS was also significantly decreased in the VD group compared to the control. EF was significantly decreased in the BD group compared to the three other groups, and it was also significantly decreased in the VD group compared to the controls. There was no significant inter-group difference in SV or CO. FS and EF were found to be decreased in patients with cerebrovascular dementia, especially BD, indicating the presence of latent left ventricular hypofunction in these patients. This finding is important in predicting the prognosis of patients and conducting treatment and prevention.
We report a case of malignant fibrous histiocytoma of the chest wall observed in a 94-year-old woman. She noticed appetite loss and general edema a week before admission. The patient was diagnosed as having congestive heart failure due to valvular heart disease on the basis of echocardiographic findings and became symptom-free by treatment with vasodilators and diuretics. However, chest roentgenogram disclosed a extrapleural mass in the left mid-lateral chest. About 2 months after admission, she experienced left lateral chest pain for the first time. The chest CT scan revealed a 5×5×2cm mass, adjacent to the lateral-posterior chest wall and projecting into the thoracic cavity and rib osteolysis. Gallium-67 citrate scintigram showed abnormal isotope accumulation in the left middle chest. Biopsy was not done. The therapeutic approach was mainly pain relief, and no tumor resection, chemotherapy, or radiotherapy was performed. The mass increased in size, and increasingly extended into the thoracic cavity on follow-up CT scans. Furthermore, marked invasion of the tumor to subcutis and subscapula was found. She died of cachexia and respiratory failure 34 weeks after admission. Histologic examination revealed malignant fibrous histiocytoma.